PubMed · 9012921
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A R Perry, S Mackinnon. 1996. Adoptive immunotherapy post bone-marrow transplantation.. https://doi.org/10.1016/s0268-960x(96)90007-7
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Allogeneic bone marrow transplantation has become routine treatment for selected patients with leukaemia and other haematological disorders. A standard measure of the efficacy of this treatment for patients is assessment of leukaemia-free survival, that is, the probability of being alive and in remission at different time intervals after transplant. During the last 10 years a new approach to managing patients who relapse after allografting was developed - namely infusion of lymphocytes (white blood cells) collected from the original donor. Such donor lymphocyte infusions (DLI) are highly effective in restoring complete remission and it appears that these remissions are durable. Consequently estimates of long-term success of allografting must consider salvage of initial relapses with DLI. To do so a new estimator of treatment efficacy, called 'current leukaemia-free survival' is sometimes used in the medical literature. This curve attempts to estimate the probability that a patient is alive in an original remission or in subsequent remission after treatment with DLI at a given time after transplant. Here we show that this estimator does not actually estimate the probability of interest and we use a multi-stage model to develop a new and more appropriate estimator for 'current leukaemia-free survival'.
Leukemia is observed with increased frequency in patients with severe congenital neutropenia (SCN). In the past decade, recombinant human granulocyte colony-stimulating factor (rh G-CSF) has prolonged the survival of patients with SCN increasingly reported to have leukemias. In this communication acute myelogenous leukemia (AML) associated with a mutation of the G-CSF receptor (G-CSF-R) developed in a patient with SCN maintained on long-term G-CSF therapy. The blast count in the blood and bone marrow fell to undetectable levels twice on withholding G-CSF and without chemotherapy administration, but the mutant G-CSF-R was detectable during this period. The patient subsequently underwent successful allogeneic bone marrow transplantation. After transplantation, the patient's neutrophil elastase (ELA-2) mutation and G-CSF-R mutation became undetectable by polymerase chain reaction. This report provides novel insights on leukemia developing in congenital neutropenia.
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